{"title":"Primary pull-through for Hirschsprung’s disease","authors":"Daniel H Teitelbaum, Arnold G Coran","doi":"10.1016/S1084-2756(03)00026-5","DOIUrl":"10.1016/S1084-2756(03)00026-5","url":null,"abstract":"<div><p>The first report of a successful primary pull-through for Hirschsprung’s disease using the endorectal pull-through (ERPT) was by So et al. (J. Pediatr. Surg. 15 (1980) 470; J. Pediatr. Surg. 33 (1998) 673). Subsequently, because of the simplified nature of this approach and the potential for cost savings, several groups have reported excellent results with this procedure. In addition to the ERPT, both the Duhamel and Swenson procedures have been performed in a one-stage fashion. More recently, primary laparoscopic approaches for each of these techniques have been utilized. The purpose of this review is to discuss the technique of primary pull-through, the peri-operative management and a summary of clinical results.</p></div>","PeriodicalId":74783,"journal":{"name":"Seminars in neonatology : SN","volume":"8 3","pages":"Pages 233-241"},"PeriodicalIF":0.0,"publicationDate":"2003-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1084-2756(03)00026-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24425634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surgical treatment of infants with necrotizing enterocolitis","authors":"Agostino Pierro, Nigel Hall","doi":"10.1016/S1084-2756(03)00025-3","DOIUrl":"10.1016/S1084-2756(03)00025-3","url":null,"abstract":"<div><p>With the improvements in neonatal intensive care, necrotizing enterocolitis (NEC) has become the most common gastrointestinal emergency amongst infants in neonatal intensive care units. The incidence of NEC varies between 1 and 8% of neonatal intensive care unit admissions and the disease has a mortality rate between 20 and 40%. There are a number of surgical options available to the paediatric surgeon depending on the clinical condition of the infant and the extent of the disease. However owing to a paucity of prospective data in this field and a lack of randomized controlled trials there is little consensus as to which is the most appropriate. Primary peritoneal drainage has become very popular in North America and Europe for the treatment of perforated NEC in very low-birthweight infants. It is a useful manoeuvre in the resuscitation of critically ill infants and in some of these infants, further operation may be avoided completely by inserting a peritoneal drain. Others however remain too unwell to undergo laparotomy and may die. Two randomized controlled trials are currently underway to determine the real benefit of peritoneal drainage. Laparotomy in very small neonates has become safer with improvements in anaesthesia and intensive care management. Resection and primary anastomosis has been proposed as a valid treatment modality in neonates with both focal and multifocal disease. The advantage of resection and primary anastomosis over stoma formation is still controversial. Different surgical techniques such as diverting jejunostomy or ‘clip and drop’ have been described to deal with extensive disease and avoid massive small bowel resection. Prospective studies and randomized controlled trials are needed to define the best operative treatment for neonates with severe NEC.</p></div>","PeriodicalId":74783,"journal":{"name":"Seminars in neonatology : SN","volume":"8 3","pages":"Pages 223-232"},"PeriodicalIF":0.0,"publicationDate":"2003-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1084-2756(03)00025-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24425633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The ex utero intrapartum treatment (EXIT) procedure","authors":"Shinjiro Hirose, Michael R Harrison","doi":"10.1016/S1084-2756(03)00029-0","DOIUrl":"10.1016/S1084-2756(03)00029-0","url":null,"abstract":"<div><p>The ex utero intrapartum treatment (EXIT) procedure was originally developed to reverse temporary tracheal occlusion in patients who had undergone foetal surgery for severe congenital diaphragmatic hernia (CDH). In a select group of foetuses with CDH, tracheal occlusion is used to obstruct the normal flow of foetal lung fluid and to stimulate lung expansion and growth. With the airway obstructed, airway management at birth is critical. The solution was to arrange delivery in such a way that the occlusion could be removed and the airway secured while the baby remained on placental support. If the uterus was kept relaxed and the utero-placental blood flow kept intact, the foetus could remain on a maternal ‘heart–lung machine’ while the airway was secured. While the technique of tracheal occlusion remains under study in clinical trials, EXIT procedures have been shown to be useful for management of other causes of foetal airway obstruction.</p></div>","PeriodicalId":74783,"journal":{"name":"Seminars in neonatology : SN","volume":"8 3","pages":"Pages 207-214"},"PeriodicalIF":0.0,"publicationDate":"2003-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1084-2756(03)00029-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24425631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Minimally invasive surgery in neonates","authors":"Keith Georgeson","doi":"10.1016/S1084-2756(03)00023-X","DOIUrl":"10.1016/S1084-2756(03)00023-X","url":null,"abstract":"<div><p>Minimally invasive surgery (MIS) has been one of the most important developments in surgery in the last century. By reducing the incision to small puncture wounds, morbidity, pain, adhesions and scarring are reduced. Due to their small size, neonates have not benefited from the advances in endoscopic surgery as rapidly as their adult counterparts. In the last 5 years, miniaturization of instruments and the development of sophisticated new techniques have enabled paediatric surgeons to apply endoscopic surgery to neonates.</p><p>MIS is now being performed in both the neonatal chest and abdomen. This article reviews these new developments and discusses the potential for even further improvements in neonatal surgery in the future.</p></div>","PeriodicalId":74783,"journal":{"name":"Seminars in neonatology : SN","volume":"8 3","pages":"Pages 243-248"},"PeriodicalIF":0.0,"publicationDate":"2003-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1084-2756(03)00023-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24425635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surgical management of cloacal malformations","authors":"Alberto Peña, Marc Levitt","doi":"10.1016/S1084-2756(03)00024-1","DOIUrl":"10.1016/S1084-2756(03)00024-1","url":null,"abstract":"<div><p>Cloaca is defined as a defect in which the urinary tract, the vagina and the rectum are fused, creating a single common channel, and opening into an orifice at the site of the normal urethra. Correct management includes an early diagnosis and adequate treatment from the newborn period. We believe that these patients are frequently misdiagnosed and consequently mistreated.</p><p>The analysis of our experience with the treatment of 330 cases allowed us to make specific recommendations to improve the management of these patients.</p><p>During the first 24<!--> <!-->h of life, emphasis is placed on the recognition and treatment of potentially lethal associated defects, mainly urologic, oesophageal or cardiac. The baby should not be taken to the operating room without ruling out these associated defects.</p><p>The basic principles of the main repair are delineated. Patients suffering from cloacas with common channels shorter than 3<!--> <!-->cm can be treated by a general paediatric surgeon, provided he or she is familiar with the procedure and observes a delicate and meticulous technique. Patients suffering from cloacas with common channels longer than 3<!--> <!-->cm belong, by definition, to a more complex type of deformity that, in order to be repaired, requires a surgeon with more experience as well as knowledge of paediatric urology.</p><p>Sixty percent of all our patients enjoy voluntary bowel movements (VBM). Seventy percent of all patients with a common channel longer than 3<!--> <!-->cm require intermittent catheterization to empty their bladder, whereas 20% of those born with a common channel shorter than 3<!--> <!-->cm require such a manoeuvre. All patients must be followed on a long-term basis in order to evaluate sexual function and care for obstetric issues.</p></div>","PeriodicalId":74783,"journal":{"name":"Seminars in neonatology : SN","volume":"8 3","pages":"Pages 249-257"},"PeriodicalIF":0.0,"publicationDate":"2003-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1084-2756(03)00024-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24425636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Discharge and aftercare in chronic lung disease of the newborn","authors":"R.A. Primhak","doi":"10.1016/S1084-2756(02)00136-7","DOIUrl":"10.1016/S1084-2756(02)00136-7","url":null,"abstract":"<div><p>This article deals with the discharge planning and continuing care of babies with chronic lung disease of the newborn (CLD), especially those with a continuing oxygen requirement, with some reference to longer term outcome. The pattern of CLD has changed since early descriptions, and the most useful definition for persisting morbidity in a baby with lung disease is a continuing oxygen requirement beyond 36 weeks post-menstrual age. Long-term oxygen therapy to maintain oxygen saturation at a mean of 95% or more and prevent levels below 90% is the cornerstone of management, and with adequate oxygen therapy the excess mortality previously reported in CLD can largely be avoided. Care must be given to the method of assessing oxygen saturation: overnight monitoring using appropriate recording devices is recommended. Exposure to respiratory viruses should be minimized where possible. Metabolic requirements are increased, but if efforts are made to maintain adequate energy input the long-term outlook for catch-up growth in height is good. Respiratory morbidity is increased in early life, but this improves in later childhood, along with lung function and exercise tolerance. Although respiratory symptoms should be treated as they arise, there is no evidence for long-term benefit from any pharmacological intervention in CLD.</p></div>","PeriodicalId":74783,"journal":{"name":"Seminars in neonatology : SN","volume":"8 2","pages":"Pages 117-126"},"PeriodicalIF":0.0,"publicationDate":"2003-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1084-2756(02)00136-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24425550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Psychosocial effects of intensive care on infants and families after discharge","authors":"Michael F. Whitfield","doi":"10.1016/S1084-2756(02)00218-X","DOIUrl":"10.1016/S1084-2756(02)00218-X","url":null,"abstract":"<div><p>The neonatal intensive care environment exposes the developing immature newborn to many sources of stress and pain at a time when the infant is developmentally least able to cope with it. Animal and human evidence suggest that effects of stress, mediated through permanent changes in the brain and neuroendocrine responses, may result in changes in behaviour and information processing, which persist throughout childhood. These changes impact on the dynamics of the mother infant dyad and infant learning. Interactional styles arising in the newborn period tend to persist throughout childhood but may be amenable to intervention focusing on maternal recognition of infant cues, social stimulation of the infant, and family integration. Developmental care may promote better family, infant and child outcomes by both reducing neonatal stress and its neurobiological sequelae, and fostering an appropriate interactional relationship between mother and infant.</p></div>","PeriodicalId":74783,"journal":{"name":"Seminars in neonatology : SN","volume":"8 2","pages":"Pages 185-193"},"PeriodicalIF":0.0,"publicationDate":"2003-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1084-2756(02)00218-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24426069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Home management of the dying NICU patient","authors":"F Craig, A Goldman","doi":"10.1016/S1084-2756(02)00223-3","DOIUrl":"10.1016/S1084-2756(02)00223-3","url":null,"abstract":"<div><p>Intensive aggressive medical therapy does not always result in cure. For some neonates it is a futile exercise that may prolong a short life of suffering. In this article, we will discuss the babies for whom aggressive therapy may not be appropriate, and how home centered palliative care can be effectively managed. We will outline the holistic multidisciplinary approach to care, with the parents as primary carers, empowered to make informed choices in the medical care of their dying baby. Symptom management will be discussed, based on the experience of an established palliative care team. We will also look at the practical and emotional preparation for death and bereavement support for the family.</p><p>We hope that more families will be given the opportunity to spend time at home with their dying baby and that, through appropriate care and support, the memory of this time will be treasured.</p></div>","PeriodicalId":74783,"journal":{"name":"Seminars in neonatology : SN","volume":"8 2","pages":"Pages 177-183"},"PeriodicalIF":0.0,"publicationDate":"2003-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1084-2756(02)00223-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24425556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Early NICU discharge of very low birth weight infants: a critical review and analysis","authors":"T.Allen Merritt , DeAnn Pillers , Susan L. Prows","doi":"10.1016/S1084-2756(02)00219-1","DOIUrl":"10.1016/S1084-2756(02)00219-1","url":null,"abstract":"<div><p>Early neonatal intensive care unit (NICU) discharge has been advocated for selected preterm infants to reduce both the adverse environment of prolonged hospital stay and to encourage earlier parental involvement by empowering parents to contribute to the ongoing care of their infant, and thereby reducing costs of care. Randomized trials and descriptive experiences of early discharge programs are critically reviewed over the last 30 years, and the key elements necessary for successful early discharge are reviewed and defined. Early discharge is clearly achievable for a large number of infants. Variations in neonatal care practices are reviewed since these variations have been documented to influence NICU stay. Management of apnea of prematurity and feeding practices is documented to significantly influence NICU length of stay, as is timing of discharge based on institutional factors. Developmentally centered care, use of nutritional supplements pre- and postdischarge, hearing screening programs, evaluation for retinopathy of prematurity, evaluation for apnea and bradycardia events, and cardiopulmonary stability while in a car seat all influence timing of discharge. Programs of early hospital discharge with home nursing and neonatologist support have been successful in lowering the length of NICU stay. However, trends in length of stay in NICUs indicate that for infants >750<!--> <!-->g at birth over the last decade there have been insignificant reductions in length of hospital stay. Thus, because of the increase in the percentage of low birth weight infants in the US, there remain opportunities to improve on variations in care that will be translated to fewer NICU days in hospitals for selected infants. Several professional guidelines are summarized, and standards of care as related to discharge of premature infants are reviewed.</p></div>","PeriodicalId":74783,"journal":{"name":"Seminars in neonatology : SN","volume":"8 2","pages":"Pages 95-115"},"PeriodicalIF":0.0,"publicationDate":"2003-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1084-2756(02)00219-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24425549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Aftercare in severe neurological impairment","authors":"M.F. Smith","doi":"10.1016/S1084-2756(02)00140-9","DOIUrl":"10.1016/S1084-2756(02)00140-9","url":null,"abstract":"<div><p>Modern neonatal intensive care has major emphasis on the resuscitation and management of infants born at the limits of viability. An additional significant group of infants are those, born at or close to term, who present with major neurological disease. This is a heterogeneous group of infants who have major care needs due to the continuing neurological abnormalities into the postneonatal period. Re-admissions to hospital are frequent and long-term developmental progress is poor. In this group of infants, there is a high early mortality. The recurrent admission of infants in this group for active resuscitation and/or intensive care may not always be the wisest management, and important medical, ethical and legal dilemmas are faced by families and carers of these infants.</p></div>","PeriodicalId":74783,"journal":{"name":"Seminars in neonatology : SN","volume":"8 2","pages":"Pages 147-157"},"PeriodicalIF":0.0,"publicationDate":"2003-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1084-2756(02)00140-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24425553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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